How to cope with insomnia during cancer treatment

Insomnia is a sleep disorder that makes it difficult to fall or stay asleep. It’s common in the general population, but it can also affect you if you’re undergoing cancer treatment like chemotherapy and radiation therapy. That’s because pain and other physical side effects from cancer treatment can disrupt sleep. So can stress and anxiety.

Sleep allows your body and mind to recover from the previous day. If you don’t get enough sleep, your body and brain can’t perform important daily tasks.

There are two main types of insomnia: long-term (chronic) insomnia lasts for three months or longer; acute insomnia occurs for fewer than three months.

There are many reasons you may develop insomnia. These include underlying health conditions, genetics and lifestyle factors.

Fortunately, it’s possible to treat insomnia.

Here‘s what you need to know about insomnia’s causes and symptoms, as well as how to manage it while you’re going through cancer treatment.

Insomnia causes during cancer treatment

In people undergoing cancer treatment, insomnia is usually a side effect of medications, treatments like radiation therapy or chemotherapy, or the stress of coping with a cancer diagnosis.

“If you're taking steroids for pain or inflammation, that can cause disruption in your sleep,” says radiation oncologist Pamela Schlembach, M.D., who sees patients at UT MD Anderson The Woodlands. “Additionally, some chemotherapy medications can directly affect neurotransmitters that regulate sleep.”

Pain and other side effects of cancer treatment — such as nausea, vomiting, frequent nighttime urination and hot flashes — can also keep you up at night.

Your environment can also be a factor, Schlembach says. If you’re sleeping in a hospital, your schedule may be interrupted by your cancer treatment or the bustle of your surroundings.

“Of course, the psychological and emotional stress of living with cancer can lead to anxiety, depression or fear of recurrence,” she says.

Insomnia may also be due to an underlying cause not related to cancer or cancer treatment, such as acid reflux, obstructive sleep apnea and bipolar disorder, as well as from lifestyle factors like jet lag or irregular work schedules.

Before starting treatment for insomnia, your healthcare team will work to determine the cause of your sleep issues.

Insomnia symptoms during cancer treatment 

The symptoms of insomnia are the same regardless of its cause. They include: 

• Daytime sleepiness
• Difficulty concentrating
• Anxiety
• Difficulty falling asleep at night
• Irritability and mood changes

Insomnia treatments during cancer treatment

There are several ways to treat insomnia. They range from improving your nighttime routine and lifestyle habits (read more on that below) to medical treatments, such as: 

• Treating the underlying cause of your insomnia, such as another medical condition or pain due to cancer or your treatment.
• Cognitive behavioral therapy, a type of talk therapy that helps you reframe negative or stressful thoughts that can disrupt your rest. This can help you address your worries about illness, treatment and outlook.
• Medications, such as:
  • Melatonin, a naturally occurring hormone that helps to regulate sleep, a naturally occurring hormone that helps to regulate sleep
  • Dual orexin receptor antagonists, such as suvorexant and lemborexant, which regulate wakefulness by blocking orexin, a chemical involved in wakefulness
  • Sedatives like zolpidem, which act on gamma-aminobutyric acid receptors to induce sleep
  • Tricyclic antidepressants like mirtazapine, trazodone or benzodiazepines, which have sedating effects

“Sleeping medications need to be monitored by a physician, and it's something you typically don't want to be on long-term due to their side effects,” Schlembach says.

How to get better sleep when you’re going through cancer treatment

There are some things you can do during the day to help you sleep better at night. These include practicing mindfulness, getting daily exercise and making healthy lifestyle choices.

Practicing mindfulness

Mindfulness may include doing your favorite hobbies like painting, spending time with loved ones, doing breathing exercises or meditating.

Exercise

Exercise can be as simple as going on a walk, riding a bike, stretching, doing yoga or using light weights. Physical activity helps your body to ease stress so you can sleep better. Aim for 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity each week, Schlembach says.

“It's really important to get some physical activity so you’re actually tired at the end of the day,” she says. “But not too late in the evening; that can interfere with sleep.”

Lifestyle changes

Eating a healthy diet rich in vegetables, fruits, whole grains, nuts and seeds, with lean proteins like chicken and fish is important to your health, including your sleep health.

Schlembach says to also look for healthy fats like those from olive or avocado oil, adding that it’s best to limit food with added sugar, sodium and refined carbohydrates.

Additionally, decreasing or avoiding caffeine, may lead to better sleep. Alcohol and tobacco products also have been linked to problems with sleep and many other health problems, including cancer. Avoid all tobacco products and aim to drink less often and have fewer drinks – for cancer prevention, it’s best to avoid all alcohol.

How to fall asleep when dealing with insomnia during cancer treatment

It’s important to get at least nine hours of sleep on most nights, Schlembach says. Practicing healthy sleep hygiene and developing a nighttime routine may help you fall asleep and stay asleep at night. Here is a list of some things you can do to create a comfortable sleep environment.

As a rule of thumb, it’s important to associate your bedroom with sleep. So, try not to use it as an office, gym, craft center or a movie theater.

Before bed

• Avoid daytime naps. Keep them to 30 minutes or less. And don't take a nap within several hours of bedtime. This can make it harder to fall asleep at night.
• Limit your food and drink intake three to four hours before bedtime. Avoid heavy meals, alcohol, chocolate or caffeinated products, such as soda, coffee or tea.
• Set a sleep schedule. Keep a bedtime and wake-up ritual, even on the weekends. Every night around the same time, take a bath, read a book or listen to music. Then, it's lights out.
• Avoid exercise too close to bedtime. This can increase your cortisol and adrenaline levels when you need to relax.
• Cut off screen time. The blue light from cell phones, tablets, TVs and computer screens suppresses melatonin, which directly interferes with sleep. So, shut off your electronic devices in the evening, and leave them off until morning. If you can't say “no,” purchase a blue light filter to help reduce eyestrain.
  

At bedtime

• Cool down your bedroom. Some research shows that the optimal bedroom temperature should be between 65 to 72 degrees F for sound sleep.
• Pull down the shades. Your bedroom should be like a cave: dark, cool and quiet. Blackout blinds, shades and fabric can minimize ambient light and help you sleep. Also be sure to cover clocks or other electronic devices that emit light in your bedroom.
• Wear comfortable clothing. Make sure you’re wearing comfortable fabrics that don’t irritate your skin and keep you at a comfortable body temperature. If your feet are cold, wear socks. Cold feet increase mental arousal.
• Try a white noise machine. If you’re sensitive to background noise, a fan or white noise device may calm your mind and block out ambient noise.

If you can’t fall asleep

• Leave the room. If you can’t sleep within five to 10 minutes of lying down, get out of bed and read a magazine or book that’s soothing or boring. If you're using a tablet or a phone, use a blue light filter. Spend time in mindfulness or use stress-relieving techniques. Once you feel tired again, go back to bed.
• Write it out. Keep a pen and paper next to your bed if you’re prone to wake up and worry about the next day's events. Jot down your reminder and fall back to sleep.

When to contact your doctor about insomnia if you’re going through cancer treatment

If you’re doing all of this and you’re still not getting enough quality sleep, contact your doctor.

Sometimes they can prescribe a sleep aid temporarily, but it should not be used for a long time.

Also contact your healthcare team if you’re experiencing pain due to your medications. They can suggest changing your medications or dosage. Together, you can come up with a plan to help you sleep soundly and pain-free.

Frequently asked questions about coping with insomnia during cancer treatment

Here are some more commonly asked questions about coping with insomnia.

What is the best cure for insomnia?

Schlembach says the best way to treat insomnia is to begin with lifestyle changes to improve your sleep hygiene.

“If those things don't work, then it's best to contact your doctor to determine whether there’s another underlying cause,” she says.

What is the 3-3-3 rule for insomnia?

The 3-3-3 rule for insomnia is a self-measurement tool. It asks if you have experienced poor sleep for at least three nights within a seven-day period, have had poor sleep hygiene for at least three months, and have had poor sleep impact your day-to-day functioning in at least three ways — such as fatigue, brain fog, mood changes or a lack of concentration.

“If the answers are yes to all three, then you need to contact a doctor,” Schlembach says.

How do medical professionals diagnose insomnia?

Your care team will begin by taking a detailed medical history, asking you about your symptoms, your medications, existing medical conditions, physical stressors and lifestyle factors.

They may also perform a physical exam to help them determine whether your symptoms are related to your cancer or cancer treatment.

They may ask you to keep a sleep journal, in which you will record the times you wake up and cannot fall asleep, as well as your symptoms and physical surroundings during that time.

If necessary, your doctor will order a sleep study, which measures nighttime wakefulness.

Curbing insomnia is a process

If you’re having trouble sleeping, it can take time to fix that. Addressing insomnia is a process.

If these suggestions don’t work, Schlembach says it’s best to contact your healthcare team to see if cognitive behavioral therapy, sleep aid medications, or a referral to a sleep specialist might be your next step.

If you are a UT MD Anderson patient with sleep issues, ask your care team for a referral to a sleep specialist at UT MD Anderson's Sleep Center.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.